New ‘PIH Reports’ Examines Comprehensive MDR-TB Care in Russia

Posted on June 06, 2014

Photo by Elena Devyashina for Partners In Health

Sputnik Program Manager Alexandra Solovyova examines a patient X-ray.

This week, Partners In Health published its second issue of “PIH Reports,” which takes an in-depth look at the Sputnik Initiative, a model of patient-centered accompaniment that provides daily support to tuberculosis and drug-resistant tuberculosis patients at the greatest risk of defaulting from treatment.

The Sputnik Initiative, launched in 2006, was designed to deliver social and clinical support for so-called “problem” patients. Most were ex-prisoners, patients who had been discharged from hospitals because of behavioral issues, and patients with addictions to alcohol and drugs. The general view was that treating them successfully was nearly impossible. Sputnik, however, shifted the onus of responsibility for adherence from the patient to the program team. This marked an important change in moral orientation: rather than being seen as “treatment failures,” patients who were unable to take their medications were considered programmatic challenges for which programmatic solutions could be found.

The Russian Federation has the third-highest burden of MDR-TB in the world. Presently, MDR-TB accounts for nearly one-third of all TB cases in Russia, or an estimated 45,000 cases per year. As noted in the report, adherence to therapy is one of the biggest challenges to treating TB and MDR-TB. This challenge is exacerbated by the social, psychological, and economic barriers Sputnik patients encounter, such as unemployment, alcoholism, and homelessness.

Over the past eight years, the Sputnik team has proven that successful treatment of these patients is possible when comprehensive social support, including daily food supplements, is woven with clinical care. The initiative has resulted in a dramatic improvement in treatment adherence, and in the number of patients who successfully complete treatment. The result of the spectrum of patient-centered interventions offered in Tomsk, Russia, is that today TB incidence in the region has dropped from 116.7/100,000 in 2000 to 62.5/100,000 in 2012.

Our experience with Sputnik offers important lessons and suggests that this platform has the potential to improve care for at-risk patients suffering from hepatitis C and HIV/AIDS, among other illnesses.